Straus touts Medicaid action

By Peggy Fikac :
March 6, 2013
: Updated: March 6, 2013 11:40pm

House Speaker Joe Straus urges fellow Republicans to “get our heads out of the sand.”

AUSTIN — Seeking to light a fire under fellow Republicans on providing health care to uninsured people, House Speaker Joe Straus said Wednesday it's time to “get our heads out of the sand” and find an alternative to Medicaid expansion that would bring billions of federal dollars to Texas.

In an interview with the San Antonio Express-News, Straus said he and other Republicans have made it clear they oppose expansion of Medicaid as the program now stands.

“But I think it's time that we said more than that. It's time that we put forth a good-faith effort to find a Texas solution,” he said.

“We need to move beyond the word 'no' to something that the administration might entertain,” Straus said. “There are no winners if nothing is agreed to. We have a very large state, a significant population of uninsured people ... and I think it could be an opportune time to put some proposals on the table that could be supported by Texas leadership.”

Straus, R-San Antonio, said the focus should be on areas including subsidies to allow people to obtain private coverage and promoting personal responsibility and cost-sharing, such as co-pays and deductibles.

Straus said there might be a way to tie a plan to a reduction in local taxes, since a key argument for expansion is that it would relieve local taxpayers of some of the burden they now bear to cover the cost of treating uninsured people in public hospitals.

Such ideas also have been talked up by other key lawmakers as they face pressure from local officials, health care providers and uninsured people to find a way to expand coverage.

While other Republican governors have found expansion doable, Gov. Rick Perry hasn't followed suit. Perry has said he'd like the flexibility that a block grant would bring, but state lawmakers have acknowledged that could be difficult for the feds to bless.

Federal officials previously have said block grants are not an option. A U.S. Department of Health and Human Services official said Wednesday that while the agency isn't currently in talks with Perry's office, it welcomes conversations with him and other governors.

Perry spokeswoman Lucy Nashed said earlier this week that the governor would continue to work with lawmakers.

The expansion allowed by the federal health care law is aimed at low-income adults who aren't part of the traditional Medicaid program.

It's estimated that expansion would mean an additional $100 billion in federal Medicaid money for Texas, which would put up $15.6 billion over that period. More than 1 million newly eligible people would get coverage.

Republicans have said they don't want to expand Medicaid as it currently exists because they consider it an unsustainable program that's taking an ever-increasing share of Texas' budget.

Some, however, have looked with interest at ideas such as Arkansas' plan to use Medicaid expansion money to buy private health insurance for poor people, which has received the federal government's go-ahead.

Senate Finance Committee Chairman Tommy Williams, R-The Woodlands, has lofted ideas such as managed-care expansion, co-pays and deductibles, and more incentives for patients to use “routine health care services” rather than emergency rooms.

Sen. Bob Deuell, a Greenville Republican who is Senate Health and Human Services Committee vice chairman, has suggested the state ask for a block grant that would allow private insurance assistance for Texans who otherwise would be eligible for coverage under the expansion.

Senate Health and Human Services Committee Chair Jane Nelson, R-Flower Mound, has said she'd like for the state to be given flexibility to use federal money as it sees fit. She has suggested as one example the potential for using Medicaid money to help poor adults buy private coverage for mental health services, rather than the state directly paying for the services with general revenue.

It's unclear exactly how the conversation will move forward, but Straus said it's important to gear up talks with the aim of building consensus behind a Texas solution.

“We need to make the right business decision for Texas taxpayers,” Straus said. “Local governments have to carry a very heavy burden and look, poor people are going to get sick. They're going to be treated. And somebody's going to pay for it.”